|Andrea Mechanick Braverman, Ph.D.
What are the medical risks of becoming pregnant at an older age? Will the older parent live long enough for his or her children to reach age 18? Will the older parent have enough vitality to be an active parent? These are the major issues addressed during Tuesday's session "Wrinkled Parents: Medical, Ethical, and Psychosocial Issues of Parenting at an Older Age."
There's no question that additional health risks come with pregnancy at an older age. Richard T. Scott, Jr., M.D., HCLD, said that older recipients of donor oocytes are at increased risk for pregnancy-induced hypertension, gestational diabetes, preterm delivery, intrauterine growth restriction, and placentation disorders.
|Richard T. Scott, Jr., M.D.
"We don't necessarily understand whether an older woman's maternal environment is intrinsically different at age 48 or age 52 or whether we just see differences in outcomes because she is more likely to have hypertension, diabetes, be overweight or have hypothyroidism," said Dr. Scott of Reproductive Medicine Associates of New Jersey, Morristown, NJ.
For example, with diabetes, the odds ratio in one case report was 1.6-fold higher in the age 35-39 range compared to age 25 but spikes to 3.43-fold higher for women age 40-44 and 4-fold higher for women over age 45 compared to age 25, he noted. For intrauterine growth restriction, evidence shows that the relative risk goes up by about 50 percent to 70 percent in women over age 35.
"When we counsel our patients, we should tell them that there are significant risks that come with age for pregnancy-induced hypertension, gestational diabetes, preterm delivery, intrauterine growth restriction, and placentation disorders," Dr. Scott said. "However, none of these are of an order of magnitude where we would counsel our patients not to pursue planning for a family."
When it comes to parental longevity, Andrea Mechanick Braverman, Ph.D., of Reproductive Medicine Associates of New Jersey, Morristown, NJ, said it may come down to a question of vitality rather than measuring length of years.
"There's more to parenting than just having a pulse," she said. "The thing that we come back to over and over again is not that you just have a pulse but rather how active are you."
Financial considerations that older parents often encounter include balancing conflicting financial demands of saving for college tuition versus retirement savings. Dr. Braverman said social issues for older parents will include the challenges of socializing with parents who may be a decade or two younger and therefore have different life and career demands. Older parents may also approach parenthood with disparate needs with one parent ready for retirement at an earlier age than the other.
Dr. Braverman additionally listed the advantages versus the disadvantages of older parenting. Advantages of older parenting include readiness, maturity, financial stability, and enjoyment, while the disadvantages included lower energy level, social stigma, a generation gap, and lack of a peer group with fellow parents.
|Judith F. Daar, J.D.
How old is too old to be a parent? A 2007 ASRM study (Braverman, Scott and Fraterrelli) found that 82.1 percent of respondents in the reproductive medicine field felt "comfortable" with intended parents being age 45 or younger, while nearly 70 percent were "uncomfortable" with intended parents being over age 50.
Some experts have recommended life expectancies of both parents should well exceed the child's by 18 years, Dr. Braverman noted.
"Attitudes have changed over the decades," she said. "Cultural norms are different, and we are now a world of many cultures, religions, and beliefs."
In addressing the legal and ethical perspectives, Judith F. Daar, J.D., Associate Dean, Whittier Law School, and Clinical Professor, University of California-Irvine School of Medicine said that no federal or state law prohibits delivery of assisted reproductive technology (ART) based on the age of a patient.
However, many countries do impose restrictions to access. For example, the National Health Service in the United Kingdom only provides ART access for women age 40 and under, while coverage is limited to couples under age 44 in Korea, and ART is national health-reimbursed in the Czech Republic until age 39. In France, postmenopausal pregnancy is prohibited entirely.
Age restrictions do promote fertility tourism, Daar noted. A 2009 European Society of Human Reproduction and Embryology (ESHRE) study found that 10 percent of European ART is delivered cross border and the average age of a fertility tourist is 38.9.
Policy considerations, Daar said, should take into account the medical risks to the mother and to the child, social risks such as quality of child rearing and the possibility of parental death early in their child's life, and psychological risks such as the impact on the child of the outlier parent (one who is older than the parents of the child's peers), and the impact of parenthood on parents.
"Ultimately, the desire for parenthood is timeless, and the reasons for parenting vary," she said. "It is an issue of reproductive liberty, and age restrictions place a substantial obstacle to procreation."